Risk factors of cytomegalovirus infection after allogeneic hematopoietic stem cell transplantation
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摘要: 目的 分析异基因造血干细胞移植(allo-HSCT)术后巨细胞病毒(CMV)感染的发生情况及其危险因素，为allo-HSCT后患者CMV感染提供防治依据。方法 回顾性分析徐州医科大学附属医院血液科于2013年1月—2021年12月收治的180例allo-HSCT患者的临床资料。统计allo-HSCT患者移植后CMV感染发生情况，将患者分为非CMV感染组和CMV感染组，比较2组间性别、年龄、移植前病毒感染情况、移植类型、人类白细胞抗原相合程度、急性移植物抗宿主病(aGVHD)发生情况等差异，并对CMV感染的危险因素进行分析。结果 180例患者中男92例，女88例，中位年龄33(6~66)岁，发生CMV感染101例，发生的中位时间为34(17~120) d，1年内累积发生率为56.1%，发生在移植后100 d内100例，占全部CMV感染者的99%。多因素分析提示预处理过程中应用抗胸腺细胞球蛋白、单倍体移植、aGVHD、β2微球蛋白的水平降低及移植后EB病毒感染为CMV感染的独立危险因素。结论 通过对CMV感染发生的相关危险因素进行分析，可及时为CMV感染做出预防治疗，减少CMV血症向CMV相关疾病发展，从而延长allo-HSCT患者的生存期。Abstract: Objective To analyze the occurrence and risk factors of cytomegalovirus(CMV) infection after allogeneic hematopoietic stem cell transplantation(allo-HSCT), and to provide the basis for prevention and treatment of CMV infection in patients after allo-HSCT.Methods Clinical data of 180 patients after allo-HSCT admitted to the Department of Hematology, Affiliated Hospital of Xuzhou Medical University from January 2013 to December 2021 were retrospectively analyzed. The incidence of CMV infection in allo-HSCT patients after transplantation was statistically analyzed, and the patients were divided into non-CMV infection group and CMV infection group. The differences between the two groups were compared including gender age, pre-transplantation viral infection, type of transplantation, degree of HLA coincidence, incidence of acute graft-versus-host disease aGVHD, and the risk factors of CMV infection were analyzed.Results Among the 180 patients, there were 92 males and 88 females, with a median age of 33(6-66) years. There were 101 cases of CMV infection, and the median time of CMV infection was 34(17-120) days. The cumulative incidence within 1 year was 56.1%, and 100 cases occurred within 100 days after transplantation, accounting for 99% of all CMV infections. Multivariable analysis indicated that ATG(antithymocyte globulin), haploid transplantation, aGVHD, β2 microglobulin and EBV(Epstein-Barr virus) infection were independent risk factors for CMV infection.Conclusion By analyzing the risk factors of CMV infection, it can carry out timely prevention and treatment for CMV infection, reduce the development of CMV-related diseases, and prolong the survival of patients with allo-HSCT.
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Key words:
- hematopoieticstem celltransplantation /
- cytomegalovirus /
- neumonia
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表 1 影响患者发生CMV感染的单因素分析
例(%) 临床特征 非CMV组
(n=79)CMV组
(n=101)χ2/Z P 性别 0.035 0.852 男 41(51.9) 51(50.5) 女 38(48.1) 50(49.5) 年龄/岁 36.0 (24.0，46.0) 30.0 (23.0，41.0) 1.417 0.033 HLA相合程度 9.116 0.003 不全相合 33(41.8) 65(64.4) 全相合 46(58.2) 36(35.6) ATG 7.233 0.007 有 54(68.4) 86(85.1) 无 25(31.6) 15(14.9) 移植前CMV感染 1.582 0.208 有 0 2(2.0) 无 79(100.0) 99(98.0) 移植前EBV感染 0.125 0.723 有 14(17.7) 20(19.8) 无 65(82.3) 81(80.2) 移植后EBV感染 4.336 0.037 有 37(46.8) 63(62.4) 无 42(53.2) 38(37.6) aGVHD 41.42 < 0.001 有 11(13.9) 62(61.4) 无 68(86.1) 39(38.6) cGVHD 1.213 0.271 有 2(2.5) 6(5.9) 无 77(97.5) 95(94.1) 原发病 3.462 0.629 AML 27(34.2) 36(35.6) ALL 23(29.1) 28(27.7) AA 13(16.5) 20(19.8) MM 2(2.5) 0 CML 5(6.3) 4(4.0) MDS 9(11.4) 13(12.9) 移植类型 7.105 0.029 单倍体移植 43(54.4) 63(62.4) 同胞全相合 34(43.0) 28(27.7) 无血缘移植 2(2.6) 10(9.9) β2微球蛋白/(ng/mL) 1 875(1 637，2 556) 2 315(1 711，2 985) -1.976 0.048 
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表 2 影响患者发生CMV感染的多因素分析
指标 回归系数 标准误差 P OR 95%CI 单倍体移植 -3.623 1.122 0.001 0.027 0.003~0.241 含有ATG 1.382 0.508 0.006 3.983 1.473~10.772 移植后EBV感染 -1.119 0.449 0.008 0.327 0.142~0.750 aGVHD -2.542 0.466 ＜0.001 0.085 0.032~0.196 β2微球蛋白 ＜0.001 ＜0.001 0.049 1.000 1.000~1.001 年龄 0.008 0.015 0.597 1.008 0.979~1.037 HLA相合程度 -1.421 0.732 0.052 0.242 0.058~1.013
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